Immobilisation / extrication jacket

Clinical Practice Procedures:
Trauma/Immobilisation/extrication jacket
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Date
February, 2015
Purpose
Scope
Author
To ensure a consistent procedural approach for the Immobilisation/extrication jacket.
Applies to all QAS clinical staff.
Clinical Quality & Patient Safety Unit, QAS
Review date
February, 2017
URL
https://ambulance.qld.gov.au/clinical.html
This work is licensed under the Creative Commons
Attribution-NonCommercial-NoDerivatives 4.0
International License. To view a copy of this license,
visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Immobilisation/extrication jacket
February, 2015
The NEANN Immobilisation and Extrication Jacket ( NIEJ )
is a device used to minimise spinal movement and assist with extrication from confined spaces.[1]
Indications
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• To facilitate safe extrication from a confined space
Contraindications
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• When the patient is actual time critical and the application of the NIEJ will delay
transport.
Complications
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• Chest straps that are too tight tend to interfere with respiratory effort.
• Groin straps need to be firmly secured to minimise jacket and neck movement during extrication.
• Incorrect head padding can lead to C-spine hyperextension or hyperflexion.
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• Immobilising the head without properly securing the torso section may cause C-spine movement.
Figure 3.91
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Procedure – Immobilisation/extrication jacket
1. Explain the procedure to the patient and gain consent.
2. Prepare the NIEJ – remove from the carry case and unroll. Set aside the
lumbar support, head supports and groin pads.
3. C-collar immobilisation should always be used in conjunction with NIEJ. Also ensure that MILS is maintained during the application of the C-collar and the NIEJ.
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Procedure – Immobilisation/extrication jacket
4. Slide the NEIJ round the back of the patient, so that it is no higher
than the top of the patient’s head. If this is not possible, position
jacket firmly in the patient’s armpits.
7. Raise the patient’s arms to shoulder height, then position the chest flaps against the chest. Apply straps from top to bottom (green, yellow, then red).
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5. Ensure the chest flaps of the device are snug under the patient’s arms. (Adjust carefully for children and pregnant patients).
8. The green straps should cross
the chest, unless the patient has chest injuries or breathing
difficulty. For the latter cases, the straps can run vertically.
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6. Release the groin straps from back of the NIEJ and hold both straps together,
ensuring they are not
twisted. Pull the groin straps down either side
between the patient and
chest flap. Slide both straps under the legs and buttocks until they are in the gluteal fold. Pull groin straps and leave.
9. For patients that need to be lifted using
the NIEJ, slide
the blue groin
pads onto
each black leg strap.
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Procedure – Immobilisation/extrication jacket
10. Use the appropriate amount of head pads to prevent hyperextension.
13. Secure the head support by applying the 25 millimetre collar strap. Do not place the strap on the jaw line as it may deform the collar or put pressure on jaw.
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14. Apply the 50 millimetre
forehead strap by attaching the side hook velcro tabs to the head flaps with the sliders level with the front of the head flaps, ensuring that the bottom of the forehead strap aligns with the bottom of patient’s eyebrows.
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11. Connect the leg
straps to the
buckles on the same side and tighten by pulling.
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12. Recheck straps to confirm
comfortable but firm fit.
15. Tighten the strap ensuring the foam pad is centred on the forehead by placing thumbs on the centre of the forehead and pulling both ends with equal force. Velcro® into place.
16. Carefully extricate the patient, maintaining spinal alignment and minimising body twisting. If necessary, the groin straps may be loosened but not removed.
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17. Provide further treatment as necessary and remove the NIEJ on arrival at hospital.
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Specialised uses of the NIEJ
• Pregnant patients: The chest flaps of the NIEJ may be folded
inwards, leaving the abdomen exposed. Exercise care in the
placement of the restraints, which should only be tensioned to provide support.
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• Paediatric patients: Adjustments may be made by placing
blankets or towels on either side of the patient to ensure support.
• Hip immobilisation: Invert the NIEJ and secure the chest flaps
over the pelvic area. Secure the head flaps around the legs, just
below the knees and use the lumbar support as padding between
the knees. Use a triangular bandage to secure the ankles,
wrapped in a figure of eight.
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e
Additional information
• The NIEJ remains in situ during transit to facilitate a log
roll in the case of vomiting.
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NOTE: The superseded version of this device, the KED,
may currently remain in use at some stations. Primarily,
principles remain the same between each piece of
equipment other than strap application. Chest straps on the KED are applied: middle (yellow), bottom (red),
legs (black) and finally the upper (green) which is left
until just prior to lifting the patient. Leg straps are applied with a sawing motion under the legs, pulling the ends of the straps up between the legs and attaching
with the white buckles on the opposite side. In groin
injury the straps are passed around each leg and UNCONTROLLED WHEN PRINTED
secured on the same
side.[2]
The green shoulder straps should cross the chest. However if the patient has chest injuries or breathing difficulty the straps can run vertically.
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